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I <br /> Send results lo: <br /> AEGIS Environmental Consultants, Inc. Aegis Environmental <br /> Phone(916)78"21 W 801 Riverside,Suite C <br /> FAX (916)786-783(1Roseville,CA 95678 <br /> Sarnplc Identification/Field Chain of Custody Record <br /> For Shell Projects Only <br /> u�v L <br /> W <br /> Site Address. <br /> AEGIS Praject#: CT/DL: <br /> t . Shell Engineer. <br /> Shipped By: Y� <br /> Shipped To: Hazardous Materials Suspected?(yes/no) <br /> Project Manager Sample No.of Analysis <br /> Sampling; T e Containers Re u+red <br /> Field ID# Date % Z"e—x , <br /> Point location <br /> M L-) <br /> � L <br /> Lit � <br /> Comments <br /> Sampler(s)(signature) Received liy(signature) <br /> Date1 i ime <br /> Field 1D Rel' wished BV(sl Mature) <br /> 17 <br /> L Z <br /> C'.r�: ' �L Datc/i'imc: ! � '� Shipment Method: <br /> Sealed for shipment by:(signature) Comments: <br /> Datc/1'imc: <br /> rived for Lab by: (signature) <br /> Receiving laboratory: r'lease return or <br /> form after signing for 1receipt Of Samples. <br />